Excessive gestational weight gain (GWG) is associated with poor maternal, perinatal, and metabolic outcomes. In non-pregnant persons living with HIV (PLHIV), integrase inhibitors (INSTIs) are associated with greater weight gain compared to protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs).
We evaluated the association of INSTI-based ART with GWG in pregnant PLHIV. The Surveillance Monitoring for ART Toxicities (SMARTT) study has enrolled pregnant PLHIV across 22 US sites since 2007. We analyzed GWG in pregnant PLHIV in SMARTT with available weight data, singleton gestations, and ART (consisting of ?3 antiretrovirals) initiation at <16 wks) gestational age (GA) from 2007-2019. GWG [(delivery weight) - (pre-pregnancy weight or weight taken at <12 wks GA)] was classified as excessive, adequate, or inadequate using National Academy of Medicine standards. ART was categorized as INSTI-based, PI-based, NNRTI-based, nucleoside reverse transcriptase (NRTI)-based, or ART consisting of ?3 antiretroviral (ARV) classes which may have included an INSTI. Modified Poisson models were fit with generalized estimating equations to assess the association of earliest ART class with prevalence of excessive (vs. adequate/inadequate) GWG. Pregnancies with ART use at conception (ART-C) and those with ART initiation in pregnancy (ART-I) were analyzed separately. Sensitivity analyses were performed with GWG modeled as excessive vs. adequate GWG.
1477 pregnancies (847 ART-C, 630 ART-I) of 1282 PLHIV were included. The prevalence of excessive, adequate, and inadequate GWG was 652 (44%), 350 (24%), and 475 (32%) respectively. Age (mean 29.3 years), earliest CD4 count (11% <200 cells/mm3) and viral load (60% < 400 copies/mL) in pregnancy, pre-gestational diabetes 3%), and GA at delivery (median 38 wks) were similar among GWG groups. No associations between ART class and excessive GWG were observed in ART-C or ART-I pregnancies after adjusting for age, race, ethnicity, income, earliest pregnancy viral load, and alcohol, tobacco, or substance use in pregnancy (Table). Results from sensitivity analyses were similar.
Initiation of INSTI-based ART prior to conception or before 16 wks GA was not associated with excessive GWG in pregnant PLHIV in the US. Future studies are needed to assess whether specific INSTIs or switching to an INSTI in pregnancy is associated with GWG.
